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 Volume 71, Number 20, November 11, 2008
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NEUROLOGY 2008;71:1609-1613
© 2008 American Academy of Neurology

Is there a link between alertness and fatigue in patients with traumatic brain injury?

G. Chaumet, MS, M. -A. Quera-Salva, MD, PhD, A. MacLeod, PhD, S. Hartley, MD, J. Taillard, PhD, P. Sagaspe, PhD, J. -M. Mazaux, MD, PhD, P. Azouvi, MD, PhD, P. -A. Joseph, MD, PhD, C. Guilleminault, MD, PhD, B. Bioulac, MD, PhD, D. Léger, MD, PhD and P. Philip, MD, PhD

From the Department of Psychology (G.C.), University of Bordeaux 2; GENPPHASS (G.C., J.T., P.S., B.B., P.P.), CNRS UMR-5227, Bordeaux; Neurological Rehabilitation Department (M.-A.Q.-S., S.H.), Garches University School of Medicine; Sleep Clinic (A.M., J.T., P.P.), University Hospital Pellegrin, Bordeaux; INRETS (P.S.), Arcueil; Center Neurological Rehabilitation Department (J.-M.M., P.-A.J.), Bordeaux University School of Medicine; Sleep Clinic (P.A., D.L.), University Hospital Hôtel-Dieu, Paris, France; and Psychiatry Department (C.G.), Stanford University School of Medicine, CA.

Address correspondence and reprint requests to Pr. Pierre Philip, Université Bordeaux 2, CNRS UMR-5227, CHU Pellegrin (GENPPHASS), Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France pr.philip{at}free.fr

Objectives: Many patients with traumatic brain injury (TBI) report chronic fatigue, and previous studies showed a potential relationship between sleepiness and fatigue in these patients. Our study first looked at the impact of objective and subjective sleepiness on fatigue in patients with TBI. We then investigated how fatigue could affect driving performance in these patients.

Methods: Nocturnal polysomnography, the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), and five 40-minute maintenance of wakefulness tests (MWT) were collected in 36 patients with TBI. Fitness to drive was assessed in a subsample of 22 patients compared to 22 matched controls during an hour simulated driving session.

Results: In patients with TBI, FSS, ESS, and mean MWT scores (±SD) were 27 ± 10, 8 ± 4, and 35 ± 7 minutes vs 15 ± 2.5, 5 ± 3, and 37 ± 5 minutes in controls. Patients with TBI reported more chronic fatigue (W = 99, p < 0.001) than controls, and, unlike in controls, the level of chronic fatigue was correlated to their MWT scores. Patients' driving performances were worse than the controls' (W = 79, p < 0.001). The best predictive factors of driving performance were fatigue scores and body mass index (multiple R = 0.458, 41.8% of explained variance).

Conclusion: In patients with TBI, chronic fatigue is significantly related to subjective and objective levels of alertness, even though these levels are not highly pathologic. This might suggest that a small level of sleepiness (i.e., MWT scores between 33 and 39 minutes) worsens fatigue in these patients. Chronic fatigue and body mass index could predict driving simulator performance in patients with TBI.

GLOSSARY: EDS = excessive daytime sleepiness; ESS = Epworth Sleepiness Scale; FSS = Fatigue Severity Scale; MSLT = multiple sleep latency tests; MWT = maintenance of wakefulness test; TBI = traumatic brain injury.

Received May 16, 2008. Accepted in final form August 6, 2008.

Supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique PHRC). G.C. was funded by a grant of Conseil Regional d'Aquitaine.

Disclosure: The authors report no disclosures.




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